Background Increasing global urbanisation has resulted in a greater proportion of the world’s population becoming exposed to risk factors unique to urban areas, and understanding these effects on public health is essential. The aim of this study was to examine the association between access to green space and mental health among adult twin pairs. Methods We used a multilevel random intercept model of same-sex twin pairs (4338 individuals) from the community-based University of Washington Twin Registry to analyse the association between access to green space, as measured by the Normalised Difference Vegetation Index and self-reported depression, stress, and anxiety. The main parameter of interest was the within-pair effect for identical (monozygotic, MZ) twins because it was not subject to confounding by genetic or shared childhood environment factors. Models were adjusted for income, physical activity, neighbourhood deprivation and population density. Results When treating twins as individuals and not as members of a twin pair, green space was significantly inversely associated with each mental health outcome. The association with depression remained significant in the within-pair MZ univariate and adjusted models; however, there was no within-pair MZ effect for stress or anxiety among the models adjusted for income and physical activity. Conclusions These results suggest that greater access to green space is associated with less depression, but provide less evidence for effects on stress or anxiety. Understanding the mechanisms linking neighbourhood characteristics to mental health has important public health implications. Future studies should combine twin designs and longitudinal data to strengthen causal inference.
Background Data on the characteristics of COVID-19 patients disaggregated by race/ethnicity remain limited. We evaluated the sociodemographic and clinical characteristics of patients across racial/ethnic groups and assessed their associations with COVID-19 outcomes. Methods This retrospective cohort study examined 629,953 patients tested for SARS-CoV-2 in a large health system spanning California, Oregon, and Washington between March 1 and December 31, 2020. Sociodemographic and clinical characteristics were obtained from electronic health records. Odds of SARS-CoV-2 infection, COVID-19 hospitalization, and in-hospital death were assessed with multivariate logistic regression. Results 570,298 patients with known race/ethnicity were tested for SARS-CoV-2, of whom 27.8% were non-White minorities. 54,645 individuals tested positive, with minorities representing 50.1%. Hispanics represented 34.3% of infections but only 13.4% of tests. While generally younger than White patients, Hispanics had higher rates of diabetes but fewer other comorbidities. 8,536 patients were hospitalized and 1,246 died, of whom 56.1% and 54.4% were non-White, respectively. Racial/ethnic distributions of outcomes across the health system tracked with state-level statistics. Increased odds of testing positive and hospitalization were associated with all minority races/ethnicities. Hispanic patients also exhibited increased morbidity, and Hispanic race/ethnicity was associated with in-hospital mortality (OR: 1.39 [95% CI: 1.14-1.70]). Conclusion Major healthcare disparities were evident, especially among Hispanics who tested positive at a higher rate, required excess hospitalization and mechanical ventilation, and had higher odds of in-hospital mortality despite younger age. Targeted, culturally-responsive interventions and equitable vaccine development and distribution are needed to address the increased risk of poorer COVID-19 outcomes among minority populations.
Background Studies have tried to link multiple aspects of the built environment with physical activity and obesity rates. Purpose To determine the relation between residential property values and multiple perceived (self-reported) measures of the obesogenic environment. Methods The Seattle Obesity Study (SOS) used a telephone survey of a representative, geographically distributed sample of 2,001 King County adults, collected in 2008–2009 and analyzed in 2012–2013. Home addresses were geocoded. Residential property values at the tax parcel level were obtained from the King County tax assessor. Mean residential property values within a 10-minute walk (833-meter buffer) were calculated for each respondent. Data on multiple perceived measures of the obesogenic environment were collected by self-report. Correlations and multivariable linear regression analyses, stratified by residential density, were used to examine the associations among perceived environmental measures, property values, and BMI. Results Perceived measures of the environment such as crime, heavy traffic, and proximity to bars, liquor stores, and fast food were all associated with lower property values. By contrast, living in neighborhoods that were perceived as safe, quiet, clean, and attractive was associated with higher property values. Higher property values were associated, in turn, with lower BMIs. The observed associations between perceived environment measures and BMI were largely attenuated after accounting for residential property values. Conclusions Perceived measures of obesogenic environments are associated with lower property values. Studies in additional locations need to explore to what extent other perceived environment measures can be reflected in residential property values.
Social capital is associated with depression independently of individual-level risk factors. We used a sample of 1586 same-sex twin pairs to test the association between seven measures of social capital and two related measures of neighborhood characteristics with depressive symptoms accounting for uncontrolled selection factors (i.e., genetics and shared environment). All measures of cognitive social capital and neighborhood characteristics were associated with less depressive symptoms in between-twin analysis. However, only measures of cognitive social capital were significantly associated with less depressive symptoms within-pairs. These results demonstrate that cognitive social capital is associated with depressive symptoms free of confounding from genetic and environmental factors shared within twins.
Our analysis provides "real-world" evidence that IVR is effective when delivered by a commercial health plan, and may be a useful tool for increasing adherence to screening guidelines among patients outside an integrated care practice.
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